It is known that patients with rheumatic diseases can show various ocular manifestations. Ocular involvement is well known in most rheumatic diseases including rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Behçet disease, anti-phospholipid syndrome, reactive arthritis and others. Their clinical expression and outcome vary between different populations. Although there are epidemiological studies on uveitis from different geographic areas, registry of patterns of eye affection among rheumatic patients in Egypt is highly deficient. Objective: To identify the prevalence and characteristics of uveitis and other patterns of immune eye involvement in patients referred to Alexandria University outpatient rheumatology clinic during the period from January 2013 to December 2013. Methods: A cross sectional analysis of a cohort of 1500 patients with immune diseases attending the outpatient rheumatology clinic was done. Of these, 100 patients had relevant eye complaints. The demographic features, clinical presentations, patterns of eye involvement, and modes of treatment of eye disease were registered for all patients. Results: 59% of the patients were female. Mean age was 39.26 years and the mean duration of systemic disease was 41 months. Mean duration of eye disease was 30 months. Behcet's disease was the most common identifiable cause of uveitis (24%) followed by JIA associated uveitis (6%) and VKH (5%). Idiopathic anterior uveitis was the most common uveitic entity representing 32% of cases. 14% needed intraocular drug injections. Topical as well as systemic steroids were added in 58%, synthetic or biological DMARDs in 14%, and surgery in 14%. Conclusions: Ocular complications are common among rheumatic patients. Awareness of the possibility of serious eye involvement should always be kept in mind. Routine ophthalmological evaluation of all patients affected with any rheumatic disease is mandatory & should be stressed upon in all guidelines & recommendations in rheumatology.
Background: Worldwide, leflunomide is a commonly used Disease-Modifying Anti-Rheumatic Drugs (DMARDs). It can be used as a monotherapy or in combination with other DMARDs to inhibit the production of inflammatory cells and accordingly reduce inflammation. Objectives: CLEAR is a multi-centric study that aims to assess the clinical efficacy and safety of leflunomide as first-line and/or add-on therapy to other DMARDs with or without steroids in Egyptian patients with active Rheumatoid Arthritis (RA). Methods: Egyptian patients with active RA for whom leflunomide was prescribed at physicians’ discretion were observed for 12 weeks. Clinical Disease Activity Index (CDAI) score, and Health Assessment Questionnaire Disability Index (HAQ-DI) score were acquired thrice during this period. This study was registered on clinicaltrials.gov (NCT03599986). Results: Interim analysis of the data collected from 337 patients (in 21 centers) showed a statistically significant decrease in the mean total CDAI score throughout the first 12 weeks of treatment (p<0.001); as the mean ±SD score decreased from 36.60 ±14.90 at baseline to reach 16.16 ±9.84 at week 12 (% reduction: 61.16 ±14.36). A statistically significant decrease (p<0.001) was also observed in HAQ-DI, as the mean ±SD score decreased from 1.46 ±0.69 at baseline to reach 0.67 ±0.54 at week 12 (% reduction: 56.11 ±27.59). Conclusion: Results of the interim analysis suggest that treatment of Egyptian patients with active RA with leflunomide (as first-line and/or add-on therapy to other DMARDs with or without steroids) for 12 weeks may be effective in terms of CDAI score and HAQ-DI score reduction and may offer an alternative for patients who experienced resistance, inadequate response or intolerance to other DMARDs.
It is known that patients with rheumatic diseases can show various ocular manifestations. Ocular involvement is well known in most rheumatic diseases including rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Behçet disease, anti-phospholipid syndrome, reactive arthritis and others. Their clinical expression and outcome vary between different populations. Although there are epidemiological studies on uveitis from different geographic areas, registry of patterns of eye affection among rheumatic patients in Egypt is highly deficient. Objective: To identify the prevalence and characteristics of uveitis and other patterns of immune eye involvement in patients referred to Alexandria University outpatient rheumatology clinic during the period from January 2013 to December 2013. Methods: A cross sectional analysis of a cohort of 1500 patients with immune diseases attending the outpatient rheumatology clinic was done. Of these, 100 patients had relevant eye complaints. The demographic features, clinical presentations, patterns of eye involvement, and modes of treatment of eye disease were registered for all patients. Results: 59 % of the patients were female. Mean age was 39.26 years and the mean duration of systemic disease was 41 months. Mean duration of eye disease was 30 months. Behcet's disease was the most common identifiable cause of uveitis (24%) followed by JIA associated uveitis (6%) and VKH (5%). Idiopathic anterior uveitis was the most common uveitic entity representing 32% of cases. 14% needed intraocular drug injections. Topical as well as systemic steroids were added in 58%, synthetic or biological DMARDs in 14%, and surgery in 14%.
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